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Bradley et al. Plast Aesthet Res 2019;6:11 I http://dx.doi.org/10.20517/2347-9264.2019.06 Page 5 of 13

Figure 4. Graph demonstrating the duration (days) between various aspect of the treatment pathway (mean, median, mode and range):
injury to initial presentation; initial presentation to outpatient department (OPD) follow-up; injury to time of operation; operation to
discharge i.e., length of hospital stay post-op; time between discharge and first follow-up

Figure 5. Graph showing the number of patients with particular clinical features in the 2016 cohort (n = 53)

There was inadequate documentation to determine the possible association of alcohol and/or illicit drug
intoxication to the injury. Regarding impact of injury, 81% (n = 43) were low impact, 15% (n = 8) were high
impact, and 4% (n = 2) was not recorded. Low impact injuries included punch-related assaults or minor
mechanical falls (less than 2 m in height), compared to RTCs, assaults from hard objects, or falls from a
significant height (greater than 2 m), which were considered high impact injuries.

Clinical features
There were 6% (n = 3) of patients who had an associated head injury, 13% (n = 7) with eye signs (e.g., diplopia,
enopthalmus, hypoglobus, limitation of eye movements), 81% (n = 43) with flattening of malar prominence
68% (n = 36) with palpable infraorbital step, 28% (n = 15) with infraorbital nerve numbness, 32% (n = 17) with
restricted mouth opening and 9% (n = 5) with malocclusion [Figure 5].

Diagnosis
Of the 53 patients in our 2016 cohort, 55% (n = 29) were isolated ZMC fractures without significant orbital
floor defect, 20% (n = 11) were ZMC fractures with other associated maxillofacial injuries, and 25% (n = 13)
were isolated zygomatic arch fractures only [Figure 6].